Calcification of hydrophilic acrylic intraocular lenses following secondary surgical procedures in the anterior and posterior segments

Abstract

AimsTo report 15 cases of intraocular lens (IOL) calcification following intraocular surgery and to identify common risk factors.MethodsA retrospective case review of patients with IOL calcification reported from the Royal Victorian Eye and Ear Hospital, Melbourne, Australia, and six surgeons in private practice in the Australian states of Victoria, New South Wales and Queensland.Results15 cases of IOL calcification were identified. Eight cases were in hydrophilic acrylic IOLs and seven in hydrophilic acrylic IOLs with hydrophobic surface properties. Five cases occurred following intraocular injection of gas during endothelial keratoplasties. Two cases occurred following pars plana vitrectomy where gas was used. The remaining eight cases did not involve the injection of any intraocular gas; six cases were following trabeculectomy surgery, and two cases were after insertion of a ‘piggyback’ sulcus IOL. In each case, the calcification had a characteristic pattern, being centrally placed in the pupillary zone, mainly affecting the anterior lens surface.ConclusionThe aetiology of IOL calcification is not fully understood, although there are known risk factors such as using hydrophilic acrylic materials and the use of intraocular gas. Surgical consideration of a patient’s ocular comorbidities before IOL implantation is an important tool to mitigate some of this risk.

Physicochemical Analysis of Sediments Formed on the Surface of Hydrophilic Intraocular Lens after Descemet’s Stripping Endothelial Keratoplasty

“…The mechanism of sediment formation on hydrophilic IOLs is being extensively studied. The literature on the subject discusses many cases of sedimentation, and also includes some ideas to describe this phenomenon [ 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 24 , 26 , 27 , 28 , 29 , 36 , 37 , 38 , 39 , 40 , 41 ]. Scherer, N C. D et al in recent investigations [ 61 ] by detailed statistical analysis of a series of 223 explanted Lentis LS-502-1 IOLs revealed as a calcification risk factor an age at implantation.…”

“…Recent studies emphasize the importance of blood-aqueous barrier breakdown [36][37][38], the coexistence of pro-inflammatory condition and repeated gas injection [39], together with the change in the hydration of the hydrophilic lens [38] in the sediment formation process. However, the authors of many papers repeatedly emphasize the lack of a well-defined mechanism of sediment formation [40,41].…”

Development of a standardized in vitro model to reproduce hydrophilic acrylic intraocular lens calcification

“…The physiological amount of phosphate in the aqueous humor is 2,19 mg/dl and typically lower than the serum concentration (3,27 mg/dl) 43 . Intraocular inflammation in patients with proliferative diabetic retinopathy (PDR), hypertension or post-surgery inflammation may alter the blood-aqueous barrier 5 , 25 . As a result, the diffusion of phosphate ions from the blood to the aqueous humor might be increased.…”

Cataract in the Adult Eye Preferred Practice Pattern®

“…843 Hydrophilic acrylic or silicone IOLs may make future surgery complicated. 881 Hydrophilic acrylic IOLs may calcify if air or gas tamponade is necessary subsequently, such as in pars plana vitrectomy, Descemet stripping endothelial keratoplasty (DSEK) or Descemet membrane endothelial keratoplasty (DMEK). 584,[882][883][884][885] In eyes at risk for corneal endothelial decompensation, it is prudent to choose another lens material.…”